Reconstruction of the external ear is one of the most challenging problems in plastic surgery because of the complex, three-dimensional properties of the auricular cartilage and overlying skin. Auricular reconstruction may benefit patients with congenital deformities and those injured in accidents or battle, but in the latter instances auricle reconstruction is often aggravated by the complexity of sustained injuries such as severe local skin damage or excessive scarring related to trauma or burns. Current clinical approaches often provide suboptimal aesthetic outcomes.
Autogenous cartilage (engineered cartilage composed of a patient's own cells) has become a feasible option for auricular reconstruction. Unfortunately, distortion and shrinkage of ear-shaped grafts or implants during scaffold degradation and lack of neocartilage maturation in vivo have hindered progress in the field. Scaffolds made of synthetic polymers often generate degradation products that cause an inflammatory reaction and negatively affect neocartilage formation in vivo. Porous collagen, a natural material, is a promising candidate; but without additional support it can not withstand the insidious contractile forces exerted by overlying soft tissue during normal wound healing. Hence, there remains a need in the art for stable, biocompatible scaffold materials and approaches to ear reconstruction that maintain the complex three-dimensional structure over the long term.